NCM-204 Community Health Nursing 1

siblings and their families and

/or grandparents.
WHAT IS A FAMILY?
 Single Adult Family
It is the basic unit of the Society  elderly man/woman living
alone.
 Provides a set of functions important to the  Multigeneration Family
needs of the individual members and to society  grandmother, daughter, and
as a whole. grand daughter ‘s nuclear.
 Provides the individual with the necessary  BLENDED FAMILY
environment for the development and  results from a union where one
interactions. or both spouses bring a child or
 Provides new and socialized members of the children from a previous
society. marriage into a new living
 Most fundamental organization in the society arrangement
 Society- the order which you live  COMPOUND FAMILY
together and cooperate or work  where a man has more than
together; have same or common goal in one spouse, approved by
the family. Philippine authorities only
 Most important social institution that serves as among Muslims by virtue of PD
the way we can transfer culture to each other. No. 1083 aka Code of Muslim
 We start interacting in our family Personal Laws of the Philippines
 We start learning within our family (Office of the President 1977)
 COHABITING FAMILY
DEFINITION OF A FAMILY  commonly described as a “ live
 It is a group of persons united by ties of in “ arrangement between an
marriage, blood or adoption; (Burgess and unmarried couple who are
Locke,1992) called common law spouses and
 A unity of interacting persons related by ties of their child or children from such
marriage, birth or adoption, who’s central an arrangement
purpose is to create and maintain a common  SINGLE PARENT
culture which promotes the physical, mental,  results from the death of a
emotional, and social development of each of spouse, separation, or
its members (Duvall, 1971) pregnancy outside of wedlock
 Composed of two or more people who are  FOSTER FAMILY
joined together by bonds of sharing and  Children whose parents can no
emotional closeness and who identify longer care for them may be
themselves as being part of the family placed in a foster or substitute
(Friedman, 2003). home by a child protection.
 Foster parents may or may not
TYPES OF FAMILY have children of their own.
 Group Network
 TRADITIONAL
 nuclear families not related by
 NUCLEAR FAMILY
birth or marriage but bound by
 defined as “ the family of
a common set of values as
marriage, parenthood, or
religious systems.
procreation; composed of a
 GAY OR LESBIAN FAMILY
husband , wife, and their
 made up of cohabiting couple
immediate children-natural,
of the same sex in a sexual
adopted or both” (Friedman et
relationship
al.,m 2003,p. 10)
 NON-TRADITIONAL
 DYAD FAMILY
 Commune Family
 consisting only of husband and
 several unrelated couple living
wife, such as newly married
together  AND SHARE
couples and “empty nesters”.
FACILITIES IN SOME FORM OF
 EXTENDED FAMILY
SOCIETY THEY COME FOR
 Consisting of three generations
ECONOMICAL REASONS ,
which may include married
BELIEFS, AND CULTURES.
 Group Marriage Commune Family-
NCM-204 Community Health Nursing 1
 several adults married to each
other , share everything
including sex and child raising.
FUNCTIONS OF THE FAMILY
 The family meets the needs of society through:
 PROCREATION
 despite the changing forms of
the family, it has remained the
universally accepted institution
for reproductive function and
child rearing .
 NOTE: Family orientation -
where you came from
 SOCIALIZATION OF FAMILY MEMBERS
 involves transmission of the
culture of a social group
 Process of learning how to
become productive
 How you are going to
communicate with the other
members of the family.
 You are involved in preparation
of children to live in the
community, interact with
people, and act outside the
family.
 STATUS PLACEMENT
 family confers its social rank on
the children
 Depending on the degree of
social mobility in a society the
family and children’s future
families may move from one
social class to another (Medina,
2001)
 Characterized by hierarchy of
its member to social classes
 Depends also to what degree
you could really have the social
mobility in the society
 Placement of members to a
larger society this would consist
a selective community
activities.
 ECONOMIC FUNCTION
 rural family is a unit of
production ( work as a team )
 They let their family
members get involved
or help in the
production for
agriculture or fisheries
 The earnings are
shared.
 urban family is more of a unit
of consumption (work
separately )
 They own their own
salaries and wages
 Specifically, the family meets the individual
needs through:
 PHYSICAL MAINTENANCE
 family provides for the survival
needs of its dependent
members.
 WELFARE AND PROTECTION
 family supports spouses or
partners by providing for
companionship and meeting
affective, sexual, and
socioeconomic needs .
 By developing a sense of love
and belonging the family gives
the children emotional
gratification and psychological
security (Medina, 2001) The
family is the source of
motivation and morale for its
members.
PATTERNS OF FAMILY ORGANIZATION
BASED ON RESIDENCE arrangements on where the
newlyweds will reside
 Patrilocal
 the married couple live with or near the
husband’s family.
 Matrilocal
 the husband leaves his family and sets
up housekeeping with or near his wife’s
family.
 Neolocal
 the married couple establish a new
home; they reside independently of the
parents of either groom or bride.
 Bilocal
 it gives the couple a choice of staying
with either the groom’s parents or the
bride’s parents
Based on authority This refers to whom the power and
decisionmaking is vested in the family.
 Patriarchy
 authority is vested in the oldest male in
the family often the father
 Matriarchy.
 authority is vested in the mother or the
mother’s kin.
 Equalitarian or Egalitarian
 husband and the wife exercise a more
or less equal amount of authority.
NCM-204 Community Health Nursing 1
 Matricentric employment, housing ) just as it is affected by
 authority is vested in the mother due to the systems within the family ( subsytem )
prolonged absence of the father.
THIS MEANS THAT:
THE FAMILY AS A CLIENT
Parke ( 2002) stated that there are three subsystems of
CHN viewed family as an important unit of the family that are most important :
health care, with awareness that the individual can be
 parent-child subsystem
best understood within the social context of the family
 Marital subsystem
It is important for nurses to work with families  Sibling-sibling subsystem
according to the following reasons :
DUVALL’S DEVELOPMENTAL STAGES AND TASK
1. The family is a critical resource
a. Importance of family in providing care STAGE TASK
BEGINNING FAMILY 1. Establish couple
to its members. Family can also
identity and mutually
improve individual members to health satisfying marriage
promotion, wellness activities. 2. Realign relationships
2. In a family unit , any dysfunction ( illness, with extended family to
injury, separation) that affects one or more include spouse
family members will affect the members and 3. Make decisions about
unit as a whole. Also referred to as “ ripple parenthood
CHILDBEARING FAMILY ( 1. Integrate infant into
effect”.
BIRTH2 ½ yrs) family
a. Ripple effect- gradually spread 2. Find mutually satisfying
influence or series of consequences ways to deal with
caused by a single action. childcare
3. “Case finding” While assessing an individual responsibilities
and family ,the nurse may identify a health 3. Expand relationships
problem that necessitates identifying risks for with extended family by
adding parenting and
the entire family.
grand parenting roles
a. As a nurse you are in the community to FAMILIES WITH 1. Socialize the children
determine who is sick and improve PRESCHOOL CHILDREN (2 2. Integrate new children
nursing care and doesn’t limit yourself ½ - 6 YRS OLD) while still meeting the
for hospital responsibilities. needs with other
4. “ Improving nursing care” children
3. Maintain healthy
a. You need to provide better and more
relationships within the
holistic care by understanding the family ( marital and
family and its members. parent-child) and
outside the family (
THE FAMILY AS A SYSTEM extended family and
community )
The General Systems Theory has been applied to the
4. Adjusting to cost of
study of families family life.
5. Adapting to the needs
- This is based on the assumption that there is a of pre-school child to
universal principle of organization that is not simulate growth and
limited to your family, you consider also the development
larger units outside the family. 6. Coping with parental
 It is a way to explain how the family as a unit loss of energy and
interacts with larger units outside the family privacy
FAMILIES WITH SCHOOL- 1. Promote school
and with smaller units inside the family (
AGED CHILDREN (6-13 y.o. achievement and foster
Friedman, 1998) ) the healthy peer
 The family may be affected by any disrupting relations with the
force acting on a system outside the family children
(suprasytem) 2. Maintain a satisfying
o Suprasystem- family formal or informal marital relationships
networks neighborhood that is your 3. Meet the physical
health needs of the
community or your neighbors.
family
 The family is embedded in social systems that 4. Adjusting to the activity
have an influence to health ( education, of school age children
NCM-204 Community Health Nursing 1
5. Promoting joint when the health needs of the family are
decisions between beyond its capability in terms of
children and parents knowledge
FAMILIES WITH 1. Balance freedom with
TEENAGERS AND YOUNG responsibility as
HEALTH AND PERSONAL DEVELOPMENT
ADULTS ( 13 -20yrs old) teenagers mature and
become more  Managing health and non-health crises 4
autonomous  Providing nursing care to sick, disabled, or
2. Maintaining open dependent members of the family
communication among
 Maintaining a home environment conducive to
parents and children
3. Supporting ethical and good health and personal development
moral values within the  Maintaining a reciprocal relationship with the
family community and its health institutions
4. Releasing adults with CHARACTERISTICS OF A HEALTHY FAMILY De Frain (1999)
appropriate rituals and and Montalvo (2004)
assistance.
5. Strengthening marital  Members interacts with each other , they
relationships. communicate and listen repeatedly in many
6. Maintaining supportive contexts
home base.  Healthy families can establish priorities .
FAMILIES LAUNCHING 1. Develop adult-adult Members understand that family needs are
YOUNG ADULTS ( 1st to relationships with
priority.
last child leaving home ) grown children
2. Expand family circle to  Health families affirm, support, and respect
include new members each other
acquired by the  The members engage in flexible role
marriage of grown relationships , share power, respond to changes
children , support the growth and autonomy of others
3. Assist aging and ill and engage in decision making that affects
parents of husband and
them
wife
4. Renew and negotiate  The family teaches societal values and beliefs
marital relationships. and shares a spiritual core.
MIDDLE AGED PARENTS 1. Strengthen marital  Healthy family foster responsibility and value
(empty nest to retirement relationship service to others
) 2. Provide health  Have the ability to cope with stress and crisis
promoting lifestyle and grow from problems . They know when to
3. Sustain satisfying
seek help with professionals
relationships with aging
parents and children
8. AGING FAMILY ( 1. Maintain satisfying
retirement to death of living arrangement
both spouses) 2. Adjust to reduced
income
3. Maintain marital
relationships
4. Continue to make sense
of one’s existence
5. Maintain
intergenerational family
ties
6. Adjust to loss of spouse

FAMILY HEALTH TASK ( Freeman and Heinrich, 1981)

 Recognizing interruptions of health or

development
 A requisite step the family has to take
to be able to deal purposefully with an
unacceptable health condition
 Seeking health care
 Refers to skills and available time the
family consults with health worker
NCM-204 Community Health Nursing 1
o Give health teaching
FAMILY NURSING PROCESS o Nursing in the community is body system
o Have a good relationship
A. Family Health Task (Freeman and Heinrich o resources that the community can utilize
1981) o provide information about resources that
1. recognizing interruptions of health or they can avail
development o barangay and health centers can assist
o a requisite step the family must take to be
them
able to deal purposefully with an
unacceptable health condition B. Characteristics of a Healthy Family (De Frain
1999 and Montalvo 2004)
2. seeking heath care
1. members interact with each other, they
o refers to skills and available time the family communicate and listen repeatedly in
consults with health worker when the many contexts
health needs of the family are beyond its 2. healthy families can establish priorities.
capability in terms of knowledge Members understand that family needs
o not all family will seek health care are priority
o family must learn how to deal with different
 Basic: physiological needs
crisis
o Need to know the family member in order
o ex.: pregnancy, schooling, no work,
to know the priorities
unplanned pregnancies
3. health families affirm, support and respect
o health and personal development
each other
3. managing health and non-health crises
4. members engage in flexible role
o financial issues, teach how to manage
relationships, share power, respond to
health/illness
changes, support the growth and
o ex.: No income since no work – do health
autonomy of others and engage in decision
teachings or plans on how to help the
making that affects them
mother for extra income (food selling,
o take turns and share powers and
recycling)
responsibilities
o members seek idea
4. providing nursing care to sick, disabled, or
o ex.: Take turns in doing something. If ikaw
dependent members of the family
ang ate pwede hindi ikaw lang lagi ang
o public health centers have different
naga lead.
programs that could provide help for the
5. family teaches societal values and beliefs
family
and shares a spiritual core
o Inform the people what the government
o we must keep and preserve our cultures
can offer
o respect different beliefs
o Passing cultural belief
5. maintaining a home environment conducive to
6. healthy family foster responsibility and
good health and personal development
value service to others
o look at the family as a whole, the
o Service oriented
environment or the family itself affecting
7. have the ability to cope with stress and
the diseased person.
crisis and grow from problems. They know
o We do not only look at the physical of the
when to seek help with professionals
patient but also the environment
o seek consultation
o To also look at probable health risks that
affect the family
C. Objectives
o Hazards and health threats
1. define the Family NSG process
o ex.: Coughing and they only have 1 room;
2. determine the steps for assessment
the other can people get affected thus must
3. distinguish 1st Level Assessment from Second
isolate the patient (inform how to separate
Level Assessment
family member who is sick)
4. Identify Health Problems of a Family
o ex.: broken stairs - health threat, self-
5. Interpret data related to the identified health
deficit; promote a home that is conducive
condition
to everybody
6. Formulate plan of care (Family) to address the
health conditions, needs, problems and issues
6. maintaining a reciprocal relationship with the
based on priorities
community and its health institutions
7. Determine Barriers to Joint Setting of Goals
NCM-204 Community Health Nursing 1
 Children may have different
FAMILY AND NURSING PROCESS
religious affiliation
is the blueprint in the care that the nurse design to  Significant others-role (s) they play in
systematically minimize or eliminate the identified family’s life
health and family nursing problems through explicitly  Relationship of the family to larger
formulated outcomes of care (goals and objectives ) and community-nature and extent of
deliberately chosen set of interventions , resources , participation of the family in
and evaluation criteria, standards and tools. community activities
o Family nursing problems: individual, health,  Housing, sleeping and living
health hazards, nutrition arrangement
o We need to do follow up  HOME AND ENVIRONMENT
 information on housing and sanitation
A. Family Health Assessment facilities, kind of neighborhood and
availability of social, health,
1. Tools for Assessment
communication and transportation
IDB (Initial Data Base ) - names, status, gender facilities
 Housing
 FAMILY STRUCTURE CHARACTERISTICS AND  Adequacy of living space
DYNAMICS (NARRATIVE FORM)  Sleeping in arrangement
 Members of the household and  Presence of breathing or resting
relationship to the head of the family. sites of vector of diseases (e.g.
 Demographic data-age, sex, civil status, mosquitoes, roaches, flies,
position in the family rodents, etc.)
 Place of residence of each member-  Presence of accident hazard
whether living with the family or  Food storage and cooking
elsewhere facilities
 Type of family structure-e.g.  Water supply-source,
patriarchal, matriarchal, nuclear or ownership, pot ability
extended  Consider the storage of
 Dominant family members in terms of the water
decision making especially on matters  Storage of food
of health care  Toilet facilities-type, ownership,
 Gathered data should be in a sanitary condition
narrative  Are they maintaining
 General family relationship/dynamics-
the condition of toilet
presence of any obvious/readily facility
observable conflict between members;  Garbage/refuse disposal-type,
characteristics, communication / sanitary condition
interaction patterns among members
 Teach how to segregate
 How do they interact with each
 Continue educating
family member?
them
 SOCIO-ECONOMIC AND CULTURAL
 Source of vector
CHARACTERISCTICS
diseases
 Income and expenses
 Drainage System-type, sanitary
 Occupation, place of work and
condition
income of each working
 They should also check
member
drainage system; no
 Adequacy to meet basic
stagnant water
necessities (food, clothing,
 Kind of Neighborhood
shelter)
 e.g. congested, slum etc.
 Who makes decision about
 Noisy neighbors
money and how it is spent
 House are too close
 Educational Attainment of each
 Social and Health facilities available
Member
 Communication and transportation
 Background
facilities available
 Ethnic Background and Religious
 Other way they
Affiliation
communicate –
cellphone, telephone
NCM-204 Community Health Nursing 1
 Transportation:
jeepney, tric, bike
 HEALTH STATUS OF EACH FAMILY MEMBERS
CAN USE THE NSG CARE PLAN HERE!
 Medical Nursing history indicating
current or past significant illnesses or
beliefs and practices conducive to
health and illness
 Nutritional assessment (especially for
vulnerable or at risk members)
 Anthropometric data:
measures of nutritional
status of
childrenweight, height,
mid-upper arm
circumference; risk
assessment measures
for obesity :
body mass
index(BMI)=weight in
kgs. divided by height in  VALUES HEALTH PRACTICES ON HEALTH
meters2),
waist circumference
(WC): greater than 90
cm. in men and greater
than 80 cm. in women),
waist hip ration
(WHR=waist
circumference in cm.
divided by hip
circumference in cm. )
Central obesity: WHR is
equal to or greater than
1.0 cm in men and 0.85
in women)
dietary
history:specifying
quality and quantity of
food or nutrient per day
Eating/ feeding habits/
practice
 Developmental assessment of infant,
toddlers and preschoolerse.g. Metro
Manila Developmental Screening Test
 Come up of your own nursing judgement
(MMDST).
 Existing potential problems that needs to be
 Assess growth of the infant utilizing
the theories of development
 Ex. Broken stairs
 Could determine the delay of the
 Presence of Wellness Condition
growth and development, IDENTIFY
 Not going to diagnose, just identify
what area the infant is delayed
 Risk factor assessment indicating presence
of major and contributing modifiable risk
factors for specific lifestyle diseases
 e.g. hypertension, physical
inactivity, sedentary lifestyle,
cigarette/ tobacco smoking,
elevated blood lipids/ cholesterol,
obesity, diabetes mellitus,
inadequate fiber intake, stress,
alcohol drinking, and other
substance abuse.
 Past health history that would
affect the current condition of the
patient
 Physical Assessment indicating presence
of illness state/s (diagnosed or
undiagnosed by medical practitioners )
 Relevant on the present condition
of the patient
 Note if there is recurrence
 Give health teachings to seek for
consultation
 Results of laboratory/diagnostic and other
screening procedures supportive of
assessment findings.
 This might be your cues
PROMOTION, MAINTENANCE AND DISEASE
PREVENTION
 Immunization status of family
members
 Healthy lifestyle practices.
 Specify Adequacy of Rest and sleep
Exercise/activities Use of protective
measure
A. e.g. adequate footwear in
parasite-infested areas; use of
bed nets and protective
clothing in malaria and filariasis
endemic areas. Relaxation and
other stress management
activities
 Use of promotive-preventive health
services
Typology of Nursing Problems in Family
Nursing Practice
FIRST-LEVEL ASSESSMENT
determined
 stated as potential or Readiness - a
clinical or nursing judgment about a
client in transition from a specific level
of wellness or capability to a higher
level. Wellness potential is a nursing
judgment on wellness state or condition
based on client’s performance, current
competencies, or performance, clinical
NCM-204 Community Health Nursing 1
data or explicit expression of desire to
achieve a higher level of state or
function in a specific area on health
promotion and maintenance.
 Examples of this are the following:
A. Potential for Enhanced
Capability for:
1. Healthy lifestyle - e.g.
nutrition/diet,
exercise/activity
2. Health
maintenance/health
management
3. Parenting - How do
they guide, teach
4. Breastfeeding
5. Spiritual well-being -
process of client’s
developing/unfolding of
mystery through
harmonious
interconnectedness
that comes from inner
strength/sacred
source/God (NANDA
2001)
6. Others. Specify_____
B. Readiness for Enhanced
Capability for:
1. Healthy lifestyle
2. Health
maintenance/health
management
3. Parenting
4. Breastfeeding
5. Spiritual well-being
6. Others Specify____
 Presence of Health Threats
 conditions that are conducive to
disease and accident or may result to
failure to maintain wellness or realize
health potential.
 lifestyle diseases, cough, family signs
beyond family resources
 how they are going to deal with family
threats- food for a big family
 conditions that are conducive to
disease and accident or may result to
failure to maintain wellness or realize
health potential.
 Examples of this are the following:
A. Presence of risk factors of
specific diseases (e.g. lifestyle
diseases, metabolic syndrome)
B. Threat of cross infection from
communicable disease case
C. Family size beyond what family
resources can adequately
provide
D. Accident hazards specify.
1. Broken chairs
2. Pointed /sharp objects,
poisons and medicines
improperly kept
3. Fire hazards
4. Fall hazards
5. Others specify.
(describe why it is
hazard)
E. Faulty/unhealthful
nutritional/eating habits or
feeding techniques/practices.
Specify.
1. Inadequate food intake
both in quality and
quantity
2. Excessive intake of
certain nutrients
3. Faulty eating habits
habits - What if mother
had no adequate
nutrient, ano makuha ni
baby
4. Ineffective
breastfeeding
5. Faulty feeding
techniques
F. Stress Provoking Factors.
Specify.
1. Strained marital
relationship
2. Strained parent-sibling
relationship
3. Interpersonal conflicts
between family
members
4. Care-giving burden
G. Poor Home/Environmental
Condition/Sanitation. Specify.
be specific on what you observe
1. Inadequate living space
2. Lack of food storage
facilities
3. Polluted water supply
4. Presence of breeding or
resting sights of vectors
of diseases
5. Improper
garbage/refuse disposal
6. Unsanitary waste
disposal
7. Improper drainage
system
NCM-204 Community Health Nursing 1
8. Poor lightning and
ventilation
9. Noise pollution
10. Air pollution
H. Unsanitary Food Handling and
Preparation
I. Unhealthy Lifestyle and
Personal Habits/Practices.
Specify.
1. Alcohol drinking
2. Cigarette/tobacco
smoking
3. Walking barefooted or
inadequate footwear
4. Eating raw meat or fish
5. Poor personal hygiene
6. Self
medication/substance
abuse
7. Sexual promiscuity
8. Engaging in dangerous
sports
9. Inadequate rest or
sleep
10. Lack of /inadequate
exercise/physical
activity
11. Lack of/relaxation
activities
12. Non use of self-
protection measures
(e.g. non use of bed
nets in malaria and
filariasis endemic
areas). No dark colored
clothes
J. Inherent Personal
Characteristics
1. e.g. poor impulse
control
K. Health History, which may
Participate/Induce the
Occurrence of Health Deficit
1. e.g. previous history of
difficult labor.
L. Inappropriate Role Assumption
1. e.g. child assuming
mother’s role, father
not assuming his role.
M. Lack of
Immunization/Inadequate
Immunization Status Specially
of Children
1. encourage them to get
immunization
2. Immunization every
Wednesday
N. Family Disunity
1. e.g. Self-oriented
behavior of member(s)
2. Unresolved conflicts of
member(s)
3. Intolerable
disagreement
O. Others. Specify._________
1. Issues within the family
that di na resolve. What
would be the effect to
each of them?
 Presence of health deficits
 instances of failure in health
maintenance.
 Examples include:
A. Illness states, regardless of
whether it is diagnosed or
undiagnosed by medical
practitioner.
B. Failure to thrive/develop
according to normal rate
C. Disability - whether congenital
or arising from illness;
transient/temporary (e.g.
aphasia or temporary paralysis
after a CVA) or permanent (e.g.
leg amputation secondary to
diabetes, blindness from
measles, lameness from polio)
 Presence of stress points/foreseeable crisis
situations
 anticipated periods of unusual demand
on the individual or family in terms of
adjustment/family resources. (What
could be the effect)
 Examples of this include:
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member - e.g.
newborn, lodger
E. Abortion
F. Entrance at school
G. Adolescence
H. Divorce or separation
I. Menopause
J. Loss of job
K. Hospitalization of a family
member
L. Death of a member
M. Resettlement in a new
community
N. Illegitimacy
O. Others, specify.___________
NCM-204 Community Health Nursing 1
SECOND- LEVEL ASSESSMENT
 Inability to recognize the presence of the
condition or problem due to:
A. Lack of or inadequate knowledge
B. Denial about its existence or severity as
a result of fear of consequences of
diagnosis of problem, specifically:
1. Social-stigma, loss of respect of
peer/significant others
2. Economic/cost implications
3. Physical consequences
4. Emotional/psychological
issues/concerns
C. Attitude/Philosophy in life, which
hinders recognition/acceptance of a
problem
D. Others. Specify _________
 Inability to make decisions with respect to
taking appropriate health action due to:
A. Failure to comprehend the
nature/magnitude of the
problem/condition
B. Low salience of the problem/condition
C. Feeling of confusion, helplessness
and/or resignation brought about by
perceive magnitude/severity of the
situation or problem, i.e. failure to
breakdown problems into manageable
units of attack.
D. Lack of/inadequate knowledge/insight
as to alternative courses of action open
to them
E. Inability to decide which action to take
from among a list of alternatives
F. Conflicting opinions among family
members/significant others regarding
action to take.
G. Lack of/inadequate knowledge of
community resources for care
H. Fear of consequences of action,
specifically:
1. Social consequences
2. Economic consequences
3. Physical consequences
4. Emotional/psychological
consequences
I. Negative attitude towards the health
condition or problem-by negative
attitude is meant one that interferes
with rational decision-making.
J. In accessibility of appropriate resources
for care, specifically:
1. Physical Inaccessibility
2. Costs constraints or
economic/financial
inaccessibility
K. Lack of trust/confidence in the health
personnel/agency
L. Misconceptions or erroneous
information about proposed course(s)
of action
M. Others specify._________
 Inability to provide adequate nursing care to
the sick, disabled, dependent or vulnerable/at
risk member of the family due to:
A. Lack of/inadequate knowledge about
the disease/health condition (nature,
severity, complications, prognosis and
management)
B. Lack of/inadequate knowledge about
child development and care
C. Lack of/inadequate knowledge of the
nature or extent of nursing care needed
D. Lack of the necessary facilities,
equipment and supplies of care
E. Lack of/inadequate knowledge or skill in
carrying out the necessary intervention
or treatment/procedure of care (i.e.
complex therapeutic regimen or healthy
lifestyle program).
F. Inadequate family resources of care
specifically:
1. Absence of responsible
member
2. Financial constraints
3. Limitation of luck/lack of
physical resources
G. Significant persons unexpressed
feelings
1. (e.g. hostility/anger, guilt,
fear/anxiety, despair, rejection)
which his/her capacities to
provide care.
H. Philosophy in life which negates/hinder
caring for the sick, disabled, dependent,
vulnerable/at risk member
I. Member’s preoccupation with on
concerns/interests
J. Prolonged disease or disabilities, which
exhaust supportive capacity of family
members.
K. Altered role performance, specify.
1. Role denials or ambivalence
2. Role strain
3. Role dissatisfaction
4. Role conflict
5. Role confusion 6.Role overload
L. Others. Specify.____
 IV. Inability to provide a home environment
conducive to health maintenance and personal
development due to:
A. Inadequate family resources
specifically:
NCM-204 Community Health Nursing 1
1. Financial constraints/limited 2. Financial resources, cost of
financial resources medicines prescribe
2. Limited physical resources - e.i. I. Feeling of alienation to/lack of support
lack of space to construct from the community, e.g. stigma due to
facility mental illness, AIDS, etc.
B. Failure to see benefits (specifically long J. Negative attitude/ philosophy in life
term ones) of investments in home which hinders effective/maximum
environment improvement utilization of community resources for
C. Lack of/inadequate knowledge of health care
importance of hygiene and sanitation K. Others, specify __________
D. Lack of/inadequate knowledge of
ASSESSMENT
preventive measures
E. Lack of skill in carrying out measures to  measuring status of the family
improve home environment  ability to maintain itself
F. Ineffective communication pattern  ability to maintain wellness
within the family  prevent, control and resolve problems
G. Lack of supportive relationship among  data are compared with the norms and
family members standards
H. Negative attitudes/philosophy in life
which is not conducive to health
maintenance and personal
development
I. Lack of/inadequate competencies in
relating to each other for mutual
growth and maturation
1. (e.g. reduced ability to meet the
physical and psychological
needs of other members as a
result of family’s preoccupation
with current problem or
condition.
J. Others specify._________
 Failure to utilize community resources for
health care due to:
A. Lack of/inadequate knowledge of
community resources for health care
B. Failure to perceive the benefits of
health care/services
C. Lack of trust/confidence in the
agency/personnel
D. Previous unpleasant experience with
health worker
E. Fear of consequences of action
(preventive, diagnostic, therapeutic,
rehabilitative) specifically:
1. Physical/psychological
consequences
2. Financial consequences
3. Social consequences
F. Unavailability of required care/services
G. Inaccessibility of required services due
to:
1. Cost constraints
2. Physical inaccessibility
H. Lack of or inadequate family resources,
specifically
1. Manpower resources, e.g. baby
sitter
NCM-204 Community Health Nursing 1
STEPS IN FAMILY NURSING ASSESSMENT
1. Data Collection (for first level assessment)
- Involves gathering of five types of data
which will generate the categories of health
conditions or problems of the family. These
data include:
o Family structure, characteristics, and dynamics
o Socio economic and cultural characteristics
o Home and environment
o Health status of each member
o Values and practices on health promotion/
maintenance and disease prevention
- METHODS ON COLLECTION:
o Observation
o Physical examination
o Interview
o Record review
o Lab/diagnostic tests
2. Data Analysis
- Sub steps:
o Sort data
o Cluster/group related data
o Distinguish relevant from irrelevant data
o Identify patterns – functions, behavior, lifestyle
o Compare patterns with norms or standards
o Interpret results
o Make inferences or conclusion
3. Problem Definition or Nursing Diagnosis
- Levels of assessment:
o First level – identifying potential and existing
problems
 Presence of well condition
 Presence of health threat
 Presence of health deficits
 Presence of stress points/foreseeable
crisis
o Second level – problems encountered by the
family in performing health tasks with the
given health condition or problem
EIGHT FAMILY HEALTH TASKS (DUVALL AND NILLER)
1. PHYSICAL MAINTENANCE
- Provides food, shelter, clothing and health
care to its members being certain that a
family has ample resources to provide
2. SOCIALIZATION OF FAMILY
- Involves preparation of children to live in
the community and interact with people
outside the family
3. ALLOCATION OF RESOURCES
- Determines which family needs will be met
and their order of priority
4. MAINTENANCE OF ORDER
- Task includes opening an effective means of
communication between family members,
integrating family values and enforcing
common regulations for all family members
5. DIVISION OF LABOR
- Who will fulfill certain roles
o Family provider, home manager, children’s
caregiver
6. REPRODUCTION, RECRUITMENT, AND RELEASE
OF FAMILY MEMBER
7. PLACEMENT OF MEMBERS INTO LARGAR
SOCIETY
- Consists of selecting community activities,
such as church, school, politics that
correlate with the family beliefs and values
8. MAINTENANCE OF MOTIVATION AND MORALE
- Created when members serve as support
people
FAMILY COPING INDEX
Purpose: to provide a basis for estimating the nursing
needs of a particular family
 HEALTH CARE NEED
 A family health care need is present when:
o Family has a health problem with which they
are unable to cope
o A reasonable likelihood that nursing will make
a difference in the family’s ability to cope
*note: relation to coping nursing need:
COPING may be defined as dealing w/ problems
associated w/ health care w/ reasonable success.
COPING DEFICIT – when family is unable to cope with or
another aspect of health care
 Direction for scaling
o 2 parts of coping index:
 A point on the scale
 A justification statement
o The scale enables you to place the family in
relation to their ability to cope with 9 areas of
family nursing at the time observed and as you
would expect it to be in 3 months or at the
time of discharge if nursing care were provided
o Coping capacity is rated from 1 (totally unable
to manage this aspect of family nursing care) to
5 (able to handle this aspect of care without
the help from community sources)
o Justification consists of brief statement of
phrases that explain why you have rated the
family as you have
- GENERAL CONSIDERATIONS:
 It is the coping capacity and not the
underlying problem that is being rated
NCM-204 Community Health Nursing 1
 It is the family and not the individual
that is being rated
 Rating should be done after 2-3 home
visits when the nurse is more
acquainted with the family
 Justification – should be expressed in
terms of behavior of observable facts
 Terminal rating is done at the end of
the given period of time. To see
progress the family has made in their
competence; whether the prognosis
was reasonable; and whether the
family needs further nursing service
and where emphasis should be placed
 SCALING CUES
o ff. descriptive statements are cues to help you
as you rate family coping. Limited to three
points
 1 or no competence
 3 for moderate competence
 5 for complete competence
 AREAS TO BE ASSESSED:
o PHYSICAL INDEPENDENCE
- concerned w/ the ability to move about to
get out of bed, take care of daily grooming,
walking and other things on daily activities
o THERAPEUTIC COMPETENCE
- procedures or treatment prescribed for the
care of ill – giving medication, dressings,
exercise, relaxation and special diets
o KNOWLEDGE OF HEALTH CONDITION
- concerned with the particular health
condition that is the occasion of care
o APPLICATION OF THE PRINCIPLES OF GENERAL
HYGIENE
- concerned with the family action in
maintaining family nutrition, securing
adequate rest and relaxation for family
members, carrying out accepted preventive
measures (immunization)
o HEALTH ATTITUDES
- the way the family feels about health care
in general, including preventive services,
care of illness and public health measures
o EMOTIONAL COMPETENCE
- maturity and integrity with which the
members of the family are able to meet the
usual stresses and problems of life, and plan
for happy and fruitful living
o FAMILY LIVING
- Concerned largely w/ the interpersonal with
the group aspects of family life
- How well the members get along with one
another
- Ways in which they take decisions affecting
the family as a whole
o PHYSICAL ENVIRONMENT
- Home, the community and the work
environment as it affects family health
o USE OF COMMUNITY FACILITIES
- Generally keeps appointments
- Follows through referrals
- Tell others about health dept services
FAMILY DATA ANALYSIS
- Socio-economic and cultural characteristics
- Home environment
- Family health status
- Family values and health practices
FAMILY NURSING DIAGNOSIS
Health Problem
 Situation or condition which interferes
the promotion and/or maintenance of
health and recovery from illness or
injury & which is subject to
change/modification through Nursing
intervention
Family Nursing Problem
 Stated as the family’s failure to
perform adequately specific health
tasks for a particular problem
 Nursing diagnosis in family nursing
practice
FORMULATING FAMILY NURSING CARE PLAN
Priority Setting
Priority Health Problems
a. Nature of the Problem - wellness state, hx
deficit, health threat and stress point/ foreseeable crisis
b. Modifiability of the Problem - probability of
success in enhancing wellness state, improving
condition minimizing, alleviating or totally eradicating
the problem.
Factors in Determining Modifiability of the
Problem
 Current knowledge, technology and
interventions
 Resources of the family
 Resources of the nurse
 Resource of the community
c. Preventive Potential - nature or magnitude of
the problem than can be minimize or totally
eradicated.
Scoring Preventative Potential
 Gravity or severity of the problem
 Duration of the problem
 Current Management
 Exposure of high risk groups
d. Salience - refers to the family’s perception and
evaluation of the condition or problem in terms
NCM-204 Community Health Nursing 1
of seriousness and urgency of attention needed
or family readiness

ESTABLISHING GOALS AND OBJECTIVES

Goal:

 A general statement of the condition or state to

brought about by specific course of action (e.g.
to improve nutrition status of the family)
CARDINAL PRINCIPLE IN GOAL SETTING

 Goal must be set jointly with family

Barriers to Joint Setting of Goals
SCORING
1. Decide on a score for each of the criteria 1. Failure to perceive the problem
2. Decide the score by the highest possible score 2. Realize the problem but too busy at the
and multiply by the weight moment
Score 3. Do not see the problem as serious enough to be
--- X Weight solved.
- Highest score 4. The problem that need to take action:
3. Sum up the scores for all the criteria. The  Fear of consequences
highest score is 5, equivalent to the total weight  Respect for tradition
The higher the score (near 5 and above) of a given  Failure to perceive the benefits
problem, the more likely it is taken as a priority  Failure to relate actions with family’
goal
5. Failure to develop working relationship from
both nurses and family

OBJECTIVES

 Refers to a more specific statements of the

desired results or outcomes of care
 The more specific the objectives, the easier is
the evaluation of their attainment

TOOLS USED IN FAMILY HEALTH ASSESSMENT

Family Health Assessment Form

o is a guide in date collection, as a means

to record pertinent information about
the family that will assist the nurse in
working with family

Genogram

o helps the nurse outline the family’s

structure. It is a way to diagram the
family.
o Three generations of family members
are included with symbols denoting
genealogy.

Ecomap
NCM-204 Community Health Nursing 1
o a classic tool is used to depict a family’s
linkages to its suprasystem
o Portrays an overview of the family in
their situation;
o It depicts the important nurturant of a
conflict laden connection between the
family and the world.
o It demonstrates the flow of resources
or the lacks and deprivation
o A mapping procedure that highlights
the nature of the interferences and
points to conflicts to be mediated,
bridges to built, and resources to be
sought and mobilized.